Provider Demographics
NPI:1881685154
Name:TENG, KATHRYN AI LING (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:AI LING
Last Name:TENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BEE CAVES RD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5869
Mailing Address - Country:US
Mailing Address - Phone:800-475-6168
Mailing Address - Fax:
Practice Address - Street 1:2500 BEE CAVES RD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5869
Practice Address - Country:US
Practice Address - Phone:800-475-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205221207R00000X
OH35-088784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22913OtherBCBS MA
OHTE7363631OtherMEDICARE
MA0105571Medicaid
OH2698568Medicaid
MA205221OtherTUFTS HEALTH PLAN
OHTE7363631OtherMEDICARE
MAJ22913OtherBCBS MA